Provider Demographics
NPI:1700364486
Name:MASCOLA-LUGO, AMELIA ROSE (PSY)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:ROSE
Last Name:MASCOLA-LUGO
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:MS
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:LUGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2512 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3506
Mailing Address - Country:US
Mailing Address - Phone:818-322-0075
Mailing Address - Fax:
Practice Address - Street 1:2512 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3506
Practice Address - Country:US
Practice Address - Phone:818-322-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty